Originally published as JCO Early Release 10.1200/JCO.2008.18.4119 on May 4 2009

This Article Full Text Full Text (PDF) Publisher's Note Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kelaidi, C. Articles by Adès, L. Search for Related Content PubMed PubMed Citation Articles by Kelaidi, C. Articles by Adès, L. Social Bookmarking                            What's this?

Improved Outcome of Acute Promyelocytic Leukemia With High WBC Counts Over the Last 15 Years: The European APL Group Experience

From the European APL group, L'Institut National de la Santé et de la Recherche Médicale U848, Villejuif, France.

Corresponding author: Lionel Adès, MD, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service d'Hématologie Clinique, Paris 13 University, 125 rue de Stalingrad, 93009 Bobigny, France; e-mail: lionel.ades{at}avc.aphp.fr.

Purpose Acute promyelocytic leukemia (APL) with pretreatment WBC counts greater than 10,000/µL is still considered to carry a poorer prognosis than APL with WBC lower than 10,000/mL. We evaluated outcome improvement in such patients in recent years.

Patients and Methods Nine hundred two patients with APL, including 204 patients and 68 patients with WBC counts more than 10,000/µL and more than 50,000/µL, respectively, were enrolled between 1993 and 2005 in two successive randomized trials of the European APL group (APL 93 and APL 2000) that tested, in particular, the modalities of combination of all-trans retinoic acid (ATRA) and chemotherapy, maintenance treatment, escalating doses of cytarabine, early administration of dexamethasone, and CNS prophylaxis.

Results Between the APL 93 and 2000 trials, the complete response (CR) rate increased from 89.6% to 93%, and the 5-year cumulative incidence of relapse (CIR) decreased from 40% to 9.5% in patients with WBC counts of 10,000 to 50,000/µL. In patients with WBC counts more than 50,000/µL, the CR rate increased from 82% to 91%, and 5-year CIR decreased from 59% to 24%. Whereas in the APL 93 trial, increased WBC counts were significantly associated with higher CIR and shorter survival, this was not the case in the APL 2000 trial. In patients with increased WBC counts, enrollment onto the APL 2000 trial (v APL 93) and combined maintenance with ATRA and chemotherapy were associated with significantly lower CIR and better survival.

Conclusion Outcome of APL with high WBC count has markedly improved over the years as a result of fewer early deaths and fewer relapses. Better initial supportive care and combined maintenance treatment have contributed to this improvement.

Supported by the programme hospitalier de recherche clinique at the centre hospitalier universitaire of Lille, France, and at the Assistance Publique Hôpitaux de Paris, the Association pour la Recherche sur le Cancer, and the Ligue contre le cancer (Comité du Nord).

This study was presented in part during the 49th Annual Meeting of the American Society of Hematology, December 8-11, 2007, Atlanta, GA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical trial information can be found for the following: NCT00599937 (APL93), NCT00591526 (APL 2000).

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. Nagai, T. Takahashi, and M. Kurokawa How Should We Prevent Hematologic Relapse of Acute Promyelocytic Leukemia? J. Clin. Oncol., February 1, 2010; 28(4): e62 - e62. [Full Text] [PDF]

				D. Grimwade, J. V. Jovanovic, R. K. Hills, E. Solomon, F. Lo-Coco, K. Wheatley, and A. K. Burnett Reply to S. Nagai et al J. Clin. Oncol., February 1, 2010; 28(4): e63 - e64. [Full Text] [PDF]

				S. Nagai, T. Takahashi, and M. Kurokawa Risk-Adapted Maintenance Therapy for Acute Promyelocytic Leukemia J. Clin. Oncol., January 10, 2010; 28(2): e21 - e21. [Full Text] [PDF]

				L. Ades, C. Kelaidi, S. Chevret, and P. Fenaux Reply to S. Nagai et al J. Clin. Oncol., January 10, 2010; 28(2): e22 - e23. [Full Text] [PDF]

				M. S. Tallman and J. K. Altman How I treat acute promyelocytic leukemia Blood, December 10, 2009; 114(25): 5126 - 5135. [Abstract] [Full Text] [PDF]